TRANSLATING INSTITUTIONAL DATA INTO UNIT SPECIFIC OUTCOME METRICS USING CUSTOMIZED NURSING SCORECARDS Debra Campbell, BSN, RN, CPHQ Mary Stevie, MS, RN Cincinnati, Ohio
Est. 1889 About TCHHN 621 Bed Tertiary Care Hospital Located near downtown Cincinnati > 5000 Employees 1400 Nurses Magnet Re - Designation-2015 Most preferred Hospital in Cincinnati for 21 years running (NRC) US News World Report Recognized as one of the top 50 hospitals in America (2000-2016) A rating in Hospital Safety Score by The Leapfrog Group (2012-2016) *The presenters for this presentation have disclosed no conflict of interest related to this topic. **All data represented is fictional.
PURPOSE & OBJECTIVES: Create a sustainable Performance Improvement infrastructure Provide Structured Formats, Standardization & Customization Correlate the Outcomes associated with Processes of Care Illustrate the impact of associated Performance Improvement work Discuss the Impact to the Provision of Care
PERFORMANCE IMPROVEMENT INFRASTRUCTURE Foundation: High Reliability Characteristics Sensitivity to Operations Preoccupation with Failure Deference to Expertise Reluctance to Simplify Commitment to Resilience HRO Organization Characteristics: Patient-centered outcomes Professional autonomy Frontline staff accountability & engagement Leadership accountability & engagement Sustaining a High Reliability Culture: Integrating Theory, EBP/Research into Practice Everyone accountable for outcomes Partnership among patient safety, quality, clinical staff and Leadership Oster, 2016 Kemper, 2009; Weick and Sutcliffe, 2007
RELEVANCE & SIGNIFICANCE Challenges in today s healthcare environment Identifying our specific gaps Starting the transformation by translating performance metrics to Nursing Leaders & Staff Mapping out process improvement and sharing ownership
OUR STRATEGY: Utilization of multiple data sources and standardized definitions for the Nursing Scorecard Midas Business Objects Patient Satisfaction Human Resources Infection Control/ Hand Hygiene Observations NSQIP (ACS National Surgical Quality Improvement Program)
OUR STRATEGY, 2: Structured Formats & Standardization All Patient Care Services receiving data for these metrics: Falls/Post Fall Huddle Unit turnover by RN & PCA Chart Audits Medication Administration Bar Coding & Scanning Patient Flow/Throughput Patient Satisfaction Infection Control (SSI s, CAUTI/CLABSI Lab confirmed, Hand Hygiene)
OUR STRATEGY, 3: Structured Formats & Standardization Nursing Units receiving data for these additional metrics: Core Measures & Weekly fallout Patient Safety Indicators (PSI) Hospital Acquired Condition (HAC) Patient Rounding Glycemic Control NDNQI (Falls, HAPU, CAUIT/CLABSI, & Patient Satisfaction)
OUR STRATEGY, 4: Customization Units receiving data for these metric: ICU s High Alert medications Endoscopy Cecum timing IV Therapy Respiratory Therapy PT/OT
SIGNIFICANCE FOR NURSING: Wisdom Gained Without integrating content, data is meaningless!
OUR METHODS: At a glance view for Nursing Leadership Fictional Data
OUR METHODS, 2: Illustration of the correlation of Process to Outcomes Patient Experience Fictional Data
OUR METHODS, 3: Customized by using a variety of Process & Outcome measures Bar Code Med Administration (BCMA) and Medication Error tracking Specific Patient Details of the medication error are placed under the graph for reference. Fictional Data
OUR METHODS, 4: Customized by using a variety of Process & Outcome measures Fictional Data
Illustrating the Impact of P.I. Work OUR METHODS, 5: Unit XYZ Units adjust their Plan/Actions according to their data. Fictional Data
Illustrating the Impact of P.I. Work OUR METHODS, 6: Units adjust their Plan/Actions according to their data. Fictional Data
OUR EVALUATION: Electronic Nursing Scorecard is expanding from our core units to include additional Patient Care Services: Emergency Department, Cath Lab, EP Lab, Network-wide Perioperative Departments (including ASC) Ability to provide real-time feedback at the Unit level Metrics are updated weekly, monthly or quarterly depending on the metric and data source Our trend analysis guides resource discussions in addition to multidisciplinary PI discussions This has resulted in 27 less emails to the manager/directors per month Serves as tool for Nursing and Performance Improvement staff to review the scorecard on a monthly basis and update the Action plan accordingly Nursing managers have reported more time for action plan development & implementation with their units
IMPLICATIONS FOR NURSING: A unit specific scorecard which summarizes process and outcome metrics has the potential to inform clinical decision making and guide the provision of nursing care. Future research is recommended to examine longitudinal data in the areas of clinical outcomes and patient experience.
REFERENCES Kemper, C & Boyle, D.K. (2009). Leading your organization to high reliability. Nursing Management, 40(4): 14-18 Oster, C. (2016). Sustaining the Culture of Safety: Strategies to Maintain the Gains. In C.A. Oster & J. Braaten (Eds.), High Reliability Organizations A Healthcare Handbook for Patient Safety & Quality. (PP.333-354). Indianapolis, IN: Sigma Thea Tau International, Honor Society for Nurses.
THANK YOU! Debra Campbell BSN, RN, CPHQ 513-585-2186 Debra.Campbell@thechristhospital.com